5.
Stroke Symptoms
1. Sudden numbness 3. Sudden trouble
or weakness of the seeing in one or both
face, arm or leg, eyes
especially on one 4. Sudden trouble
side of the body walking, dizziness,
loss of balance or
2. Sudden confusion, coordination
trouble speaking or
understanding 5. Sudden, severe
headache with no
known cause
Source: American Heart Association website: 9
http://www.americanheart.org/presenter.jhtml?identifier=4742 Last accessed 9/6/07
Important Stroke Facts
Only 17% of Americans can accurately
identify signs of stroke and recognize the
need to call 911 immediately
Rapid treatment of strokes is critical
Source: American Heart Association: Preventing and Treating Stroke, Legislator Policy Brief
10

6.
Types of Stroke
Hemorrhagic - occurs when a blood
vessel in the brain breaks leaking blood
into the brain
Ischemic - occurs when arteries are
blocked by blood clots or by the gradual
build-up of plaque and other fatty
deposits
Transient Ischemic Attack (TIA) -
stroke symptoms that always last less
than 24 hours before disappearing
Source: Definitions from National Stroke Association website accessed 8/13/07 11
Virginia Stroke Statistics
20,674 stroke patient discharges from Virginia
hospitals in 2006*
2000-06 average is 21,170 strokes*
3,681 Virginians died from a stroke (2004)**
For every 100,000 Virginians, 54 died from a
stroke (2004)**
For every 100,000 Black Virginians, 79 died
from a stroke (2004)**
Sources: *Compiled from discharge data provided by Diane Hillman Dr.H.A, ** Virginia Department of Health 12

8.
Stroke Center Designations
Designations are for baseline informational purposes not for
accreditation purposes
Only “Primary Stroke Center” designation is complete and refined enough for
a hospital accreditation
Levels
1 - Comprehensive Stroke Center (CSC) can provide care for all levels of
acute, sub-acute and chronic stroke and stroke related conditions as well
as for the most complex stroke patients. No current certification process.
2 - Primary Stroke Center (PSC): Defined by the Joint Commission
(formerly the Joint Commission on Accreditation of Healthcare
Organizations).
3 - Basic Stroke Care (BSC): Has not become certified PSC but has many
of the components of a PSC.
4 - Initial Entry Access (IEA): Typically a smaller institution with a very
limited stroke population and/or PSC capability only during weekday
working hours. They may treat and transport or elect to transfer hyper-
acute strokes and have implemented telemedicine/teleradiology, transfer
agreements and pre-planned transfer.
Source: Acute Stroke Care Hospital Roles, American Heart Association 15
Patient Discharges by Stroke Types
for all Virginia Hospitals – CY2006
12,000 Hemorrhagic strokes
Other are the most likely to be
10,000 fatal
Expired
8,000
Transfer to Other
Institution Ischemic strokes
6,000 Discharge to
Home represent the highest
level of discharge to
4,000
other institutions
2,000 This includes skilled
nursing facilities (SNF)
0 and rehabilitation centers
Hemorrhagic Ischemic TIA Other
Discharges
Source: Diane Hillman, Dr.H.A. Presentation to
Stroke Systems Workgroup July 11, 2007 16

14.
A Stroke Systems Workplan Was
Created and Approved
27
28 Strategy Recommendations for
Stroke System Task Force*
3 6 15 6 4
3 Availability of public support to treat indigent and uninsured stroke victims
Number of target strategies denoted above each area of care
Recommendations include: strategy description, partners, tools,
resources, accomplishments, next steps, and measures.
•*Some strategies apply to more than one area, therefore the sum of the areas is greater than the total number of approved strategies
•Graphic created by VDH and modified by JCHC staff 28

15.
Strategy Recommendation
Examples
Public Awareness:
A-2: Engage partners in implementing awareness for high-risk
populations
Identify existing educational programs and resources and develop
strategies to promote and provide access to them.
Emergency Response Protocols:
B-3: Promote the Use of Most Current Recommended
Diagnostic Algorithms and Protocols by Emergency Medical
Dispatchers
Put strategies in place to:
Provide for the most advanced level of prehospital care available,
Have consistent use of and prompt updating of established standards
of response by EMS dispatchers, particularly non-traditional (ie, police,
non-EMD).
29
Strategy Recommendation
Examples (Cont’d)
Primordial, primary and secondary prevention of
stroke:
A-7: Engage Partners in Providing Professional Education
Relevant to Stroke Prevention
Encourage and support provision of professional education
related to diagnoses and control of risk factors for stroke, in a
format with measurable outcomes related to practice change.
Rehabilitation of stroke patients:
E-1: Provide for and Promote Standardized Rehabilitation
Screening Early in Treatment
Ensure that all stroke patients receive a standard screening
evaluation during the initial hospitalization, with emphasis on
assessment of all residual impairments.
30

18.
Policy Options
Option 3: Designate certain hospitals as
“Primary Stroke Centers”
Amend the Code of Virginia to grant the
Department of Health’s Commissioner the authority
to designate certain hospitals to be a “Primary Stroke
Center” when accredited as a “Primary Stroke
Center” by the Joint Commission or similar
designation by another equivalent national
accrediting body. (Similar to trauma designations)
35
Policy Options
Option 4: Establish hospital guidelines for
stroke treatment
JCHC support either or both:
4A - Amend the Code of Virginia to mandate that all hospitals
establish a protocol for the rapid evaluation and subsequent
admission or transfer of the stroke patient.
4B - Letter from JCHC chairman to VHHA requesting
assistance on encouraging all hospitals to establish a protocol
for the rapid evaluation and subsequent admission or
transfer of the stroke patient.
36

19.
Policy Options
Option 5: EMS regional Councils to develop
regional stroke patient destination plans.
Amend the Code of Virginia to require each regional
EMS Council to create a uniform destination plan for
prehospital stroke patients, with partners including
the Office of Emergency Medical Services (OEMS)
and public safety answering points (PSAPS), as well
as other organizations as deemed appropriate.
37
Policy Options
Option 6: VDH briefing on OEMS medical
record data collection system in 2008
Request by letter of the Chairman that OEMS
report to JCHC in 2008 regarding progress in
developing a centralized electronic medical
record data collection.
38

20.
Policy Option
Option 7: Improving care coordination
for Medicaid stroke patients
Request by letter of the Chairman that
Department of Medical Assistance Services
(DMAS) investigate the option for care
coordination service payments for those who
have had a stroke.
39
Policy Option
Option 8: Expedited Medicaid review for
acute stroke patients
Request by letter of the Chairman that
Department of Social Services (DSS) and
DMAS investigate an expedited Medicaid
determination review for acute stroke
patients.
40

21.
Public Comments
Written public comments on the proposed
options may be submitted to JCHC by close of
business on October 31, 2007. Comments may
be submitted via:
E-mail (sareid@leg.state.va.us)
Facsimile (804/786-5538) or
Mail to Joint Commission on Health Care
P.O. Box 1322
Richmond, Virginia 23218
Comments will be summarized and presented to
JCHC during its November 8th meeting.
41